How to Recognize and Treat Bed Sores (Decubitus Ulcers): Stages, Symptoms, Causes and Natural Treatments

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Foxx_301115Bed sores or decubitus ulcers are particularly concerning for any individuals with movement difficulties—thankfully there are bed sores treatment options. Pressure and friction cause the skin and underlying tissue to erode away, resulting in bedsores. In minor cases, they are uncomfortable and painful.

In extreme cases, they can lead to a gaping, open hole in the body that becomes a prime source of infection.

Causes of Bedsores

A bedsore happens when localized, sustained pressure cuts off the blood flow to parts of the skin. Deprived of blood, the tissue begins to die and wither.

This happens most often in areas that lack much in the way of muscle or fat or that possess hard inner elements like bone. As a result, sustained pressure most often causes bedsores along the spine, tailbone, shoulder blades, hips, knees, and elbows, but they can happen anywhere on the body.

Friction and shear can also weaken the skin and make developing bedsores more likely. Friction occurs when the skin is dragged against another surface, like when a person rolls over. Shear occurs when two surfaces are moving in opposite directions, such as when twisting. This will contort and possibly damage the blood vessels in the area, furthering the development of a bedsore.

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Risk Factors for Bed Sores

Certain other factors will increase a person’s risk of developing a bedsore and many are of particular concern to the elderly.

  • Age: The skin becomes thinner, drier, and less elastic as we get older. This makes breakdown and damage more likely.
  • Immobility: Being bedridden or confined to a wheelchair causes a large risk of bedsores due the sustained pressure involved. This is why most bedsore cases occur in hospitals or nursing homes.
  • Excessive dryness or moisture: Dry skin increases friction and is easier to damage. Moist skin increases friction and shear.
  • Poor Nutrition: A certain amount of nutrients and fluids are needed to maintain skin quality and restore lost cells. Poor nutrition increases the risk of damage and slows recovery.
  • Illness: People with diabetes and circulatory conditions are at a higher risk of tissue damage from inadequate blood flow.
  • Smoking: Nicotine negatively impacts circulation and impairs the healing process.
  • Spasms: Certain medical conditions can result in uncontrolled muscle spasms. Despite being a form of movement, these spasms can actually increase bedsore risk because the motions routinely apply friction and shear force to the skin.
  • Impaired awareness or senses: Someone who lacks full mental awareness is at risk of developing bedsores, especially if it is combined with a form of immobility. Weakened perception and communication can make it less likely for someone to communicate that they are suffering from pain or discomfort.
  • Coma: For obvious reasons, coma patients cannot move or communicate and don’t respond to discomfort or pain. A comatose person is at high risk of getting a bedsore since they are dependent on the observation and care of others.

Bedsores can develop surprisingly fast depending on the patient’s condition and the type of surface involved. For example, a malnourished elderly person lying on a hard bed or operating table can develop a bedsore within a few hours.

Symptoms and Stages of Bed Sores

Bedsores have four stages of classification depending on how severe they are. A bedsore can be harder to notice initially but will become very apparent in the later stages.

Stage 1

  • Persistent red skin; may be bluish/purple in people with darker skin.
  • Itchy and painful.
  • May feel warm, firm, or spongy.
  • The area will not lighten when touched.
  • Skin is unbroken.

Stage 2

  • The outer layer of the skin has been lost.
  • The open wound appears shallow and pink or red.
  • May appear like a blister, ruptured or intact, with a clear fluid.
  • Can appear shiny or dry.

Stage 3

  • Crater-like, deep wound that has exposed the subcutaneous fat or tissue.
  • Presence of yellowish, dead tissue inside the wound.
  • Skin loss in an area wider than the visible opening suggests.
  • High risk of infection.

Stage 4

  • Muscle, fat, tendons, or bone become exposed and possibly damaged.
  • The wound contains necrotic, yellow, crusted tissue.
  • Spectacular risk of infection.

There are two additional types of bedsores that are important to keep in mind. The first is an “untyped” or “unstaged” bedsore. As the name suggests, these arise when there is too much wounded or dead tissue in the way to tell how deep the bedsores have become.

The second is what is called a deep tissue injury, which is a closely related condition that is caused in the same way as a bedsore. The primary difference is that the surface of the skin is not broken even though there has been significant tissue loss in the underlying layers, making identification more difficult. A deep tissue injury has the following symptoms:

  • Skin is warmer or cooler compared to its surroundings.
  • May appear maroon or purple.
  • Can feel “mushy” and painful.
  • A thin, dark blister can form.
  • A layer of eschar (dead tissue) can quickly form.

Natural Treatments for Bed Sores

Bedsore treatment involves relieving pressure on the area while working to care for the wound as it heals. The difficulty of this task will increase as the bedsore becomes more advanced.

Pressure relief for the affected areas: Relieving pressure involves a combination of repositioning and supporting surfaces. For someone who is bedridden, this can involve being rotated or rolled every few hours with assistance if necessary. Patients in wheelchairs can try shifting their weight every fifteen minutes or so, with help if needed. Support surfaces include things like mattresses and pillows, whether filled with foam, water, or air, that are used to both provide cushioning to the areas under pressure but also to help keep the body in a supportive position.

Cleaning and applying new dressings regularly: Caring for a bedsore involves a combination of keeping the area clean and properly apply dressings to prevent infection. Stage 1 sores can be cleaned by a gentle wash with mild soap and a pat dry. Other stages will need a saltwater or saline solution to be used each time the dressing is changed. The kind of material and method used for dressing the bedsore will depend on your doctor’s recommendation. Depending on the location and severity of the bedsore you may be able to take care of the dressing yourself or require assistance.

Home Remedies for Bed Sores

  • Vitamin C: Take 500 milligrams of vitamin C thrice daily—it has anti-inflammatory properties and can promote healthy skin.
  • Zinc oxide ointment: Apply a treatment of zinc oxide ointment mixed with aloe vera to the affected area. Zinc is effective with wound healing.
  • Turmeric root/goldenseal: Apply a mixture of goldenseal and turmeric root to the area to speed up recovery and help prevent further infection.
  • Sugar and honey compress: Apply a sugar and honey compress over the wound to help draw out toxins and to speed up the healing process.

Other measures undertaken when managing bedsores can include painkillers, antibiotics, dietary improvements, and physical therapy to improve mobility. The best way to handle a bedsore is, of course, not to get one in the first place. Be aware of the risk factors, limit pressure when you can, and talk to your doctor about prevention methods should you find yourself bedridden or in a wheelchair for any duration.

The first step to treating bed sores is learning how to recognize bed sores. Try the home remedies listed above to treat bed sores—and make sure to speak to your doctor about further bed sore treatments.

Sources for Today’s Article:
“Bedsores (pressure Sores),” Mayo Clinic web site, December 13, 2014; http://www.mayoclinic.org/diseases-conditions/bedsores/basics/definition/con-20030848.

“What Are Bed Sores (pressure Ulcers)? What Causes Bed Sores?” Medical News Today web site, November 27, 2015; http://www.medicalnewstoday.com/articles/173972.php.


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Dr. Richard Foxx, MD

About the Author, Browse Richard's Articles

Richard M. Foxx, MD has decades of medical experience with a comprehensive background in endocrinology, aesthetic and laser medicine, gynecology, and sports medicine. He has extensive experience with professional athletes, including several Olympic competitors. Dr. Foxx practices aesthetic and laser medicine, integrative medicine, and anti-aging medicine. He is the founder and Medical Director of the Medical and Skin Spa located in Indian Wells, California, at the Hyatt Regency Resort. Dr. Foxx is certified by the National Board of Medical Examiners... Read Full Bio »